Access to health care in rural communities has been a major challenge for decades. Rural communities are managing through health provider shortages, and higher rates of preventable deaths, including those due to injury, heart disease, cancer, and suicide. According to a December 2019 piece in Health Affairs, these issues affect one in five Americans who lives in a rural area. These problems persist among adults as well as children and youths, and this is before considering the effects of the COVID-19 pandemic.
The good news is that value-based payment presents an opportunity to gain strong financial footing and continue delivering excellent care in rural communities. We all know health providers must shift from fee-for-service and toward value-based payment in the next few years to maintain their incomes. The intention of value-based payment is to control health care costs while maintaining a high quality of care.
How does Caravan Health help rural providers succeed in value-based payment?
Caravan Health has a unique view into helping rural health providers succeed in value-based payment. Between 2016 and 2018, Caravan supported about half of the rural ACOs in the ACO Investment Model, also called AIM. The results were astounding. AIM is one of the most successful alternative payment models in CMS’ history. Through shared savings, AIM ACOs repaid $52.1 million of the $96.2 million in funding and did so while maintaining a consistently high quality of care.
The key to rural value-based payment is engaging in the difficult work of practice transformation. Caravan starts by taking a look at primary care delivery in each practice, making sure there are population health nurses available to deliver services, such as annual wellness visits and chronic care management, that lead to strong health outcomes along with important streams of new revenue that create financial stability. Our team-based population health methodology means that each practice and health system in the ACO place high-need patients on a care plan so everyone on the care team is up to date on preventive care.
Much of this type of population health work is new for our small, rural partners, and we work alongside each practice to properly position them for the best possible start. Each client partners with a Caravan team that includes a Regional Vice President who makes sure that no balls get dropped as the practice begins ACO work. Caravan’s clinical practice improvement managers work with clinicians to anticipate any issues, solve problems, and offer guidance along the way. Each practice also has access to our quality and compliance teams to ensure they are updated on the latest program changes.
Can my practice really afford to start in an ACO?
Through our years of experience, we have demonstrated that transforming your practice through ACO work actually pays for itself, including rural providers. That’s one reason why we call joining an ACO a “financial no-brainer.” The total investment for an average provider, including population health nurse staff and our tools, training, and expertise, will cost approximately $50 – 75 per attributed Medicare beneficiary per year. While that can be a significant investment for a small health practice, that same provider will earn $375 in new revenue for each attributed Medicare beneficiary each year. These are real dollars generated by our clients across the nation who have transformed their practice with the ACO model, and you can too.
The newly generated revenue comes from population health services delivered by nursing staff, optimizing your 340B drug discount program, and earning shared savings by outperforming your ACO benchmark. In addition, you can earn bonuses from participating in the Merit-based Incentive Payment System (MIPS) or an advanced alternative payment model (A-APM). Both the MIPS and A-APM bonuses are designed to position high quality at the center of patient care.
What is the best way to get started?
For a limited time, there is a unique opportunity for rural providers to get started in a Caravan Health collaborative ACO with no upfront costs and no exposure to downside risk. Caravan is stepping up to support rural providers while CMS has delayed the ACO track of the new Community Access and Rural Health Transformation (CHART) ACO model for at least one year. This offer opens the door for rural providers who are ready to transition to value-based payment and the important work of practice transformation without waiting through the delay.
How do we know this works?
There is plenty of evidence that rural providers can improve care and thrive in value-based payment. Caravan recently honored a couple of our rural partners with Population Health Pioneer awards. Read below for more on their stories.
Ashley Kilpatrick, Director of Care Coordination at Sullivan County Community Hospital (SCCH) in Sullivan, IN, received the Caravan Health Population Health Nurse of the Year Pioneer Award. Ashley is improving care for her patients every day by understanding and addressing the social disparities that create barriers to care. For example, she found that care coordination services for a patient who lived along and did not drive kept the patient up to date with appointments and out of the hospital.
Karen Koenig, a registered nurse and Population Health Manager at the Alcona Health Center in Oscoda, MI, is another honoree for Caravan’s Nurse of the Year award. Alcona has been in a Caravan ACO since 2014, and in that time the population health department has doubled. This capacity helped Alcona to get through the COVID-19 pandemic by keeping sight of patients with chronic conditions that could have been overlooked during the coronavirus crisis.
To learn more about Caravan Health and our strategies for rural value-based payment, check out our webinar about our rural no-cost, no-risk offer and our recent podcast, Health Care by the Numbers with a panel of AIM participants. You can reach us at firstname.lastname@example.org.